Provider Demographics
NPI:1073618476
Name:RICH, LYNNE D (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:D
Last Name:RICH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6805 W COMMERCIAL BLVD
Mailing Address - Street 2:#285
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-2116
Mailing Address - Country:US
Mailing Address - Phone:954-232-0717
Mailing Address - Fax:
Practice Address - Street 1:6805 WEST COMMERCIAL BOULEVARD
Practice Address - Street 2:#285
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319
Practice Address - Country:US
Practice Address - Phone:954-232-0717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3545103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59368AMedicare PIN